Summary
Definition
History and exam
Key diagnostic factors
- hearing loss
- ear discharge resistant to antibiotic therapy
- attic crust in retraction pocket
- white mass behind intact tympanic membrane
Other diagnostic factors
- tinnitus
- otalgia
- altered taste
- dizziness
- facial nerve weakness
Risk factors
- middle ear disease
- eustachian tube dysfunction
- otologic surgery
- traumatic blast injury to ear
- congenital anomalies
- family history
Diagnostic tests
1st tests to order
- pure tone audiogram
- CT scan of the petrous temporal bones
Tests to consider
- fistula test
- MRI scan of the head and petrous temporal bones
- bacterial culture
Treatment algorithm
all patients
Contributors
Authors
Susan A. Douglas, MBBS (Hons) UWI, FRCSEd, FRCS (ORL-HNS)
Consultant Otolaryngologist and Otologist
Rotherham NHS Foundation Trust
Rotherham
UK
Disclosures
SAD declares that she has no competing interests.
Peer reviewers
Cliff Megerian, MD
Professor and Vice Chairman of Otolaryngology
Case Western Reserve University School of Medicine
Cleveland
OH
Disclosures
CM is an author of a reference cited in this topic.
Iain Swan, MD, FRCS
Senior Lecturer in Otolaryngology
Honorary Consultant Otolaryngologist
Glasgow Royal Infirmary
Glasgow
UK
Disclosures
IS declares that he has no competing interests.
References
Key articles
Kuo CL, Shiao AS, Yung M, et al. Updates and knowledge gaps in cholesteatoma research. Biomed Res Int. 2015;2015:854024.Full text Abstract
Castle JT. Cholesteatoma pearls: practical points and update. Head Neck Pathol. 2018 Sep;12(3):419-29.Full text Abstract
Isaacson G. Diagnosis of pediatric cholesteatoma. Pediatrics. 2007 Sep;120(3):603-8. Abstract
Bhutta MF, Williamson IG, Sudhoff HH. Cholesteatoma. BMJ. 2011 Mar 3;342:d1088. Abstract
Ayache D, Darrouzet V, Dubrulle F, et al. Imaging of non-operated cholesteatoma: clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Jun;129(3):148-52. Abstract
American College of Radiology. ACR appropriateness criteria: hearing loss and/or vertigo. 2018 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Chronic suppurative otitis media
- Otitis externa
- Benign necrotizing otitis externa
More DifferentialsGuidelines
- Hearing loss in adults: assessment and management
- Otitis media with effusion in under 12s
More GuidelinesPatient information
Middle ear infection
Outer ear infection
More Patient informationVideos
How to examine the ear
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